cardiac emergencies

Question 1

CAD risk factors (6)

Answer 1

• over 40 yo, male or postmenopause
• hypercholesterolemia
• DM, obesity, HTN, sedentary
• fam hx
• tobacco, cocaine
• HIV infection

Question 2

use of CXR in chest pain

Answer 2

to r/o other causes like pneumonia, pneumothorax

Question 3

aortic dissection, PE would be seen best on what kind of imaging

Answer 3

CT angiography

Question 4

what kind of radiography would be good for low risk ACS

Answer 4

coronary CTA

Question 5

D-dimer is gotten to r/o what?

Answer 5

PE

Question 6

4 HEART risk fx:

Answer 6

• HTN, hypercholesterolemia
• DM, obesity (BMI >30 kg/m²)
• smoking (current, or smoking cessation ≤3 mo)
• positive family history (1st deg. with CVD before age 65)

Question 7

HEART risk score (low vs intermediate vs high)

Answer 7

• low is 0-3
• intermediate is 4-6
• high is 7+

Question 8

leading cause of adult mortality in the US

Answer 8

ACS

Question 9

chest pain w/ no clear alternative cause, and no clear evidence of cardiac injury or stress on ECG and biomarker tests

Answer 9

low probability ACS

Question 10

chest discomfort lasting short amount of time; provoked with exertion/stress

Answer 10

stable angina

Question 11

rest angina, prolonged >20 mins
new onset angina w/ significant physical limitation
previously diagnosed angina becoming longer or more often

Answer 11

unstable angina

Question 12

what med should be avoided with stable angina

Answer 12

NSAIDs

Question 13

you do not use nitroglycerin for what type of MI

Answer 13

inferior wal MI

Question 14

2 tx options for STEMI less than 12 hrs

Answer 14

• PCI
• fibrinolytics

Question 15

IABP is used for ____ or ____

Answer 15

acute MR or RV infarct

Question 16

nitroglycerin, nitroprusside, loop diuretics are used for afterload reduction in ____tensive HF

Answer 16

HYPER

Question 17

• Airway, ventilation, oxygenation
• noninvasive ventilation early, and sit patient upright!
• Nitroglycerin (BP > 150/100) - Reduce BP by 20%–30%

Answer 17

acute pulmonary edema management

Question 18

when do you use nitroprusside in acute pulmonary edema

Answer 18

If elevated BP, persistent sx despite Max IV Nitro

Question 19

Dx– endocardial biopsy is gold standard, ECG changes, troponin elevation, cardiac MRI

Answer 19

myocarditis dx

Question 20

classic ECG findings of
* PR segment depression
* Diffuse ST elevations
* low voltage QRS
* Electrical alternans– think tamponade

Answer 20

pericarditis

Question 21

which imaging is diagnostic for pericarditis

Answer 21

echo

Question 22

which HEART score gets admitted with low probability ACS

Answer 22

• 4-6

Question 23

which HEART score gets early revascularization with low probability ACS

Answer 23

7+

Question 24

you should avoid what med class in AR unless its from an aortic dissection

Answer 24

BB

Question 25

sudden onset of 6 Ps, normal contralateral limb

Answer 25

embolic acute limb ischemia

Question 26

6Ps of acute limb ischemia

Answer 26

pain pallor paralysis pulseless paresthesia polar

Question 27

4 chronic risk factors of occlusive PAD

Answer 27

* Age, smoking, diabetes, hyperlipidemia

Question 28

ABI values for chronic vs life threatening occlusive PAD

Answer 28

* chonic < 0.9 * life threatening < 0.25

Question 29

ways to manage occlusive PAD

Answer 29

* Vascular surgery consult * Unfractionated heparin * Aspirin 325 mg * Pain control * Environment protection * Vascular surgery

Question 30

# what does this describe: intima violation, blood into media and dissects btwn intima and adventitia, creating false lumen

Answer 30

aortic dissection

Question 31

# what does this describe: intima violation, blood into media and dissects btwn intima and adventitia, creating false lumen

Answer 31

aortic dissection

Question 32

Sudden onset severe, sharp or ripping/tearing chest pain radiating to back b/w scapulae | this is the general descriptor for what?

Answer 32

aortic dissection | can have sx of stroke, anterior cord syndrome, Horner’s syndrome

Question 33

____ tension is more common in aortic dissection while ____ tension is more common in AAA

Answer 33

* hyper--- dissection * hypo--- AAA | if hypo in dissection, thats a bad prognosis

Question 33

____ tension is more common in aortic dissection while ____ tension is more common in AAA

Answer 33

* hyper--- dissection * hypo--- AAA | if hypo in dissection or new AR, thats a bad prognosis

Question 34

two imaging in evaluating aortic dissection and what are their findings

Answer 34

CXR: widened mediastinum CTA: evaluate anatomy

Question 35

Severe abrupt onset back pain, abdominal pain, flank pain, +/- syncope, shock, ischemic limb

Answer 35

AAA

Question 36

HR and SBP goals when reducing shear force in aortic dissection

Answer 36

HR under 60 BP under 160 (ideally 100-120)

Question 37

first 2 med to give in aortic dissection

Answer 37

* esmolol bolus + drip * labetolol bolus + PRN | they are negative inotropes/BB

Question 38

2nd two meds to give in aortic dissection that can be given first to avoid reflex tachycardia?

Answer 38

* Nitroprusside * Nicardipine | vasodilators given PRN

Question 39

which type of aortic dissecton is tx with medical management unless refractory

Answer 39

type B

Question 40

which type of aortic dissection is tx emergently

Answer 40

type A or complicated B